Healthcare Provider Details

I. General information

NPI: 1164190559
Provider Name (Legal Business Name): RGV MOBILE DYSPHAGIA DIAGNOSTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16905 NACAHUITA LN
HARLINGEN TX
78552-2894
US

IV. Provider business mailing address

16905 NACAHUITA LN
HARLINGEN TX
78552-2894
US

V. Phone/Fax

Practice location:
  • Phone: 956-491-0620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AUDRA GAIL SOTO
Title or Position: OWNER
Credential: MS. CCC-SLP
Phone: 956-648-8762